Fecal incontinence remains a problem after laparoscopic surgery

Sep 19 2012

By medwireNews Reporters

Fecal incontinence improves after surgery for rectal prolapse, but research shows that the degree of improvement is quite low.

After a mean follow-up period of 36 months, 68% of surgically treated patients had a reduction in the continence score.

In spite of this, nearly 60% of patients remained incontinent, with 55% reporting urgent incontinence and 32% reporting passive leakage.

"Despite an improvement in quality of life and symptoms, fecal incontinence remains a frequent and troublesome complaint after surgery for rectal prolapse," say researcher Laurent Siproudhis (Universitaire de Pontchaillou, Rennes, France) and colleagues.

The study, published in Colorectal Disease, included 85 patients undergoing laparoscopic rectoplexy to treat full-thickness rectal prolapse between 2003 and 2009.

Prior to referral for surgery, the patients had symptoms for nearly 4 years and 10 individuals had prior surgery for rectal prolapse. Fecal incontinence was the main symptom prior to surgery, reported in 46% of patients, but 88% of individuals had some degree of incontinence before the laparoscopic procedure.

Three years after surgery, 58 patients, or 68%, had an improvement in fecal continence, with the mean incontinence score declining from 10.4 before surgery to 7.0 after surgery, a statistically significant difference.

However, 58.9% of patients remained incontinent. Incontinence for liquid stool, for solid stool, and the need for protection was observed in 51%, 41%, and 51% of patients, respectively.

"Despite a significant surgical effect on continence at least one half of the study group still required pads and/or suffered from fecal incontinence," report the researchers.

Older patients, individuals with symptoms for a longer duration, individuals with a higher preoperative urinary incontinence score, and those with a higher fecal incontinence score were more likely to suffer with postoperative incontinence.

In a logistic regression analysis, the presence of symptoms for more than 1 year was associated with a significant ninefold increased risk for postoperative incontinence compared with symptoms for 12 months or less (odds ratio [OR]=8.97).

Similarly, patients with a preoperative Cleveland Clinic Incontinence Score above 4 had a more than sevenfold increased risk for postoperative incontinence compared with those with a lower score (OR=7.47).

Laparoscopic prosthetic rectoplexy typically has a high satisfaction rate among patients, providing relief from rectal prolapse and improvements in continence. Despite the less invasive nature of the procedure, Siproudhis et al suspect that the "degree of improvement of continence may be inferior to that of the open procedure."

However, they note that a head-to-head randomized trial failed to show a treatment difference among patients treated with the noninvasive and open surgeries.

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